Clinical Investigation On The Treatment Of Hepatocellular Carcinoma Via Transarterial Chemoembolization With Indigenous Drug-eluting Beads

ObjectiveTo compare clinical short-term efficacy and the safety of interventional embolization with CalliSpheres-loaded microspheres and conventional TACE(cTACE)in inoperable hepatocellular carcinoma.MethodsIn this retrospective study,42 consecutive patients were collected from the first Affiliated Hospital of Zhejiang University from November 2015 to April 2016.All patients undergoing cTACE or DEB-TACE with CalliSpheres-loaded microspheres and MRI a week before and the first month,third month,and sixth month after initial therapy were included.The imaging and clinical data followed up were summarized and analyzed.The tumor response,lesion recurrence,complications and side effects of interventional therapy were focused and compared.ResultsForty-two patients treated with TACE met the inclusion criteria.In all,20 patients(47.6%)received cTACE and 22 patients(52.4%)DEB-TACE.There were no differences due to sex,tumor burden,Okuda stage,Child-Pugh stage,Barcelona clinic liver(BCLC)cancer tumor staging,portal thrombosis or extrahepatic tumor manifestation.According to mRECIST criteria,1 month after treatment of DEB-TACE vs c-TACE,the Disease remission rate(CR+PR)of being 70.6%and 56.3%(p=0.481),respectively,Disease control rate(CR+PR+SD)being 94.1%and 81.2%(p=0.335),respectively;3 month after treatment of DEB-TACE vs c-TACE,the Disease remission rate of being 58.8%and 43.8%(p=0.494),respectively,Disease control rate being 76.5%and 75.0%(p=1.000),respectively;6 month after treatment of DEB-TACE vs c-TACE,the Disease remission rate of being 23.5%and 25.0%(p=1.000),respectively,Disease control rate being 58.8%and 62.5%(p= 1.000),respectively.The two groups after interventional treatment in patients with adverse reactions such as fever,nausea,vomiting and fatigue.BUT,there are no significant differences.The hospital stay are no significant differences,[cTACE(4.8±2.0)d,DEB-TACE(7.4±7.0)d,p=0.273].There are no significant differences in postprocedural abdominal pain in22.7%and 15.0 of patients treated with DEB-TACE and cTACE,respectively.But,there was a Severe pain treated with DEB-TACE,needed hydromorphone to remittent.Local or extrafocal recurrence of HCC 3 months and 6 months after the initial TACE.No differences between the cTACE and DEB-TACE could be detected.However,there was a trend toward a higher rate of extrafocal recurrence in patients treated with DEB-TACE,On the contrary,a trend toward a higher rate of recurrence Starting from the tumor edge department with cTACE.DEB-TACE and cTACE patients did show a trend toward a higher increase in transaminase,TBil(total bilirubin),PT(pt prothrombin time)levels and a trend toward a lower reduce in cholinesterase,AFP after intervention,differences did not reach statistical significance Between the two groups.There were two patients demonstrated therapy-related hepatic locoregional Biliary injuries after 3 mothes with DEB-TACE,Biliary injuries included biliary cast,bile duct dilatation,and intrahepatic biloma.Conclusion1.There were no statistically significant differences between cTACEgroup and DEB-TACE group with regard to the short-term response and side effects.Instead,some patients with heavier conventional abdominal pain after interventional therapy of DEB-TACE were observed.2.Local or extrafocal recurrence of HCC after the initial TACE.No differences between the cTACE and DEB-TACE could be detected.Although it's never been confirmed,it's understood that there was a trend toward a higher rate of extrafocal recurrence in patients treated with DEB-TACE,On the contrary,a trend toward a higher rate of recurrence starting from the tumor edge department with cTACE.3.Drug-eluting beads TACE(DEB-TACE)have been proposed as a novel drug delivery embolization system,able to deliver higher dose of the chemotherapeutic agent to the tumour,to slowly and selectively release chemotherapy into the tumor and to prolong the contact time of the drug with neoplastic cells.TACE-related hepatic locoregional toxicity may be heavy of drug-eluting beads TACE(DEB-TACE)in patients,the damage to the normal bile duct,blood vessels,and liver tissue can not be ignored,suggesting that cTACE might be more appropriate than DEB-TACE in patients with less advanced cirrhosis.